Pre-Authorization Nurse

Job Description

Job Description

Job Summary

We are seeking a detail-oriented Pre-Authorization Nurse for a temp-to-hire opportunity in Guaynabo, PR within the insurance industry. This role is ideal for a nursing professional who enjoys clinical review, service coordination, coverage evaluation, and working closely with providers and policyholders to support timely healthcare decisions.

The Pre-Authorization Nurse plays an important role in ensuring requested services are reviewed accurately, aligned with clinical protocols, and documented properly. This opportunity offers a structured healthcare environment where teamwork, accuracy, communication, and sound clinical judgment are valued. Candidates can expect to work with supportive leadership, established guidelines, and cross-functional teams focused on quality service and appropriate care coordination.

Key Responsibilities

- Receive, review, and evaluate service requests according to established clinical criteria, policies, and protocols.
- Coordinate services with providers, verify coverage terms, review codes, and confirm that requested services align with treatment needs.
- Refer requests that do not meet clinical criteria to the appropriate medical officer or medical advisor for further review.
- Communicate case resolutions to policyholders and providers in a professional and timely manner.
- Document all interventions, determinations, follow-ups, appeals, and service request activity in the electronic system.
- Identify cases appropriate for Disease Management or Case Management and follow up on rental equipment cases when needed.

Compensation and Benefits

- Salary: $38,000 per year.
- Job Type: Temp-to-Hire.
- Location: Guaynabo, PR.

Equal Opportunity Employer / Disabled / Protected Veterans

The Know Your Rights poster is available here:

-06/22-088_EEOC_KnowYourRights6.12.pdf

The pay transparency policy is available here:

- transp_%20English_formattedESQA508c.pdf

For temporary assignments lasting 13 weeks or longer, the Company is pleased to offer major medical, dental, vision, 401k and any statutory sick pay where required.

We are committed to working with and providing reasonable accommodations to individuals with disabilities. If you need a reasonable accommodation for any part of the employment process, please contact your staffing representative who will reach out to our HR team.

AppleOne participates in the E-Verify program in certain locations as required by law. Learn more about the E-Verify program.

verify.uscis.gov/web/media/resourcesContents/E - Verify_Participation_Poster_ES.pdf

We also consider for employment qualified applicants regardless of criminal histories, consistent with legal requirements, including, if applicable, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance. Pursuant to applicable state and municipal Fair Chance Laws and Ordinances, we will consider for employment-qualified applicants with arrest and conviction records, including, if applicable, the San Francisco Fair Chance Ordinance. For Los Angeles, CA applicants: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

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\nCompany Description

This company offers growth and a great group of people to work with.

Company Description

This company offers growth and a great group of people to work with.